In this April 26, 2017 file photo supporters of single-payer health care march to the Capitol in Sacramento, Calif. The state Senate approved, SB562 by Democratic State Senators Ricardo Lara, of Bell Gardens, and Toni Atkins, of San Diego, that would guarantee health coverage with no out-of-pocket cost for all California residents, including people living in the country illegally.(Photo: Rich Pedroncelli/AP)

As Republicans continue to push reforms reducing the government's role in health care, some opponents are emboldened in their support for the opposite approach, one that greatly increases the government-health care link.

Progressive politicians and activists see a future in single-payer health care, the term for a government-run health insurance program that would be available to any American. While a Democratic-backed federal bill has no future in the GOP-led Congress, backers have had more success at the state level.

Republicans in the U.S. Senate on June 22 unveiled their version of plans to overhaul the Affordable Care Act. While official estimates won't come until next week, a similar plan passed by the U.S. House was expected to leave 23 million Americans uninsured and increase out-of-pocket costs for the sick and elderly.

Following the election of President Trump, Jimmi Kuehn-Boldt of Palm Springs began advocating for single-payer health care with the grassroots group Courageous Resistance. At 63, he doesn't expect anything to take effect before he's eligible for Medicare in a little over a year, but he said he's worried about seeing care for others deteriorate if Republicans are successful.

The Senate proposal makes any talk of single-payer, either in Washington or Sacramento, "just as important, if not more than before," Kuehn-Boldt said.

"We've got to see how it's fleshed out in Washington, but we can still move forward here," he added.

Senate Majority leader Mitch McConnell leaves the chamber after announcing the release of the Republicans' healthcare bill which represents the party's long-awaited attempt to scuttle much of President Barack Obama's Affordable Care Act, at the Capitol in Washington, Thursday, June 22, 2017. (AP Photo/J. Scott Applewhite)(Photo: J. Scott Applewhite/AP)

More than 100 Democrats in the U.S. House have signed on to a single-payer bill introduced by Rep. John Conyers of Michigan called Medicare for All because it would eliminate the current 65-and-over requirement for Medicare. Sen. Bernie Sanders of Vermont has talked about introducing his own plan.

In California, where Democrats hold strong majorities and the governorship, a bill to create a statewide single-payer program passed the state Senate June 1.

But that momentum stalled last week when state Assembly Speaker Anthony Rendon of Lakewood announced he was holding the bill in committee until further notice.

In a statement, Rendon called the bill, SB 562, "woefully incomplete."

"Even senators who voted for SB 562 noted there are potentially fatal flaws in the bill, including the fact it does not address many serious issues, such as financing, delivery of care, cost controls, or the realities of needed action by the Trump Administration and voters," Rendon said.

The plan would provide broad coverage, including the essential health benefits spelled out in the Affordable Care Act. The bill says enrollees would not pay co-payments or deductibles.

State Sen. Toni Atkins of San Diego, one of two Democratic sponsors of the bill, has said that even if the Affordable Care Act remains intact, the state can do more to cut costs and improve access.

Atkins issued a statement June 22 calling the U.S. Senate health bill more than mean, as Trump has reportedly called it, but "simply wrong."

"We will continue to demand the quality healthcare we all deserve," Atkins said. "If Congress passes this bait-and-switch, we will fight here at home to ensure that Californians remain covered.”

Price remains a major question for California's plan and has made the bill a non-starter for some Republican lawmakers. A recent estimate put the cost at $400 billion annually with half of that needing to come from new revenue.

Gov. Jerry Brown, a Democrat who also roundly criticized congressional Republicans on Thursday, has not said if he would sign a single-payer health plan into law.

Besides California, lawmakers in New York have been hammering out their own single-payer plan.

The state’s legislation, called the New York Health Act, had passed the Democrat-led Assembly three times before 2017, but it repeatedly stalled in the Republican-leaning Senate, which represents more rural upstate New York versus the urban New York City metro area, and mirroring the U.S. political divide.

Debate over federal health care law this year prompted a renewed push to pass the New York Health Act, but it once again passed the state Assembly only to die in the Senate. The legislative session adjourned this week.

Assemblyman Richard Gottfried, a Democrat from Manhattan, has championed the single-payer push in New York. He described it as an example for states to expand the federal Medicare program for the elderly to the entire population.

“What is going on in Washington is making it clearer than ever that the only way Americans can get access to health care is through Medicare-for-all legislation starting in the states,” Gottfried said.

Dr. Oliver Fein, chair of the New York metro chapter of Physicians for a National Health Program, a single-payer advocacy group, on Thursday focused on Republican-led efforts to cut funding for Medicaid, the joint state-federal health program for millions of poor and disabled.

“That is likely to be a huge destabilizing factor not just for the patients themselves, the people who will be denied coverage, but frankly for the whole hospital system because hospitals really do depend on Medicaid income,” Fein said.

Both Fein and Gottfried spoke about Congress’ plans to overhaul health care in terms of re-energizing efforts for single-payer, despite opponents questioning how states would overcome cost and logistical hurdles.

New York’s single-payer plan calls for income-based tax increases to pay for expanding state-run health coverage, with the wealthy shouldering a larger percentage of the cost.

While the single-payer tax increases have drawn criticism, lawmakers, hospital leaders and voters have held numerous rallies in New York to voice concerns about how proposed cuts to Medicaid could leave the state with a major budget hole.

Gottfried pointed to the mounting opposition to Congress’ push to overhaul health care as potentially being the long-awaited catalyst needed to ignite single-payer plans.

“Whatever the Republicans in Washington do is going to take billions of dollars out of health care in New York State, and the only way New York can afford to fill those gaps and protect ourselves is with the New York Health Act,” Gottfried said.

David Robinson reports for The Journal News in White Plains, New York. Desert Sun Health reporter Barrett Newkirk can be reached at (760)778-4767, barrett.newkirk@desertsun.com or on Twitter @barrettnewkirk.